Essentials: Professional Pride and Reinforcement

As demonstrated too often in the past, even a single lapse in technique or attention in the compounding of CSPs can cause great harm or death to a patient. Lab Safety has directly trained and verified the competency of many hundreds of CSP compounding operatives for more than twenty-five years. In that time, we have verified that a proper attitude and professionalism on the part of these personnel are essential to assuring and maintaining their flawless skill sets and disciplines. These attributes must be motivated by a successful ‘group dynamic’ to generate the core sense of commitment and pride necessary to assure a safe and unvarying CSP system.

Flawless compounding skills require more than the mere presentation of information to become part of a high quality CSP regimen; only when CSP personnel rally as an effective team is the true importance of their joint mission fully realized and embraced. This team spirit must be inspired by a competent and motivated leader who is willing to share the secrets to success, reaffirm the crucial mission of both the compounder and the team as a whole, and demonstrate the focus of management on constant quality improvement (CQI) of CSP’s.

The VALITEQ Aseptic Verification System is, therefore, designed to promote group participation within a dynamic, interactive educational forum, rather than the use of individual computer distance learning methods which cause isolation from other team members and the resulting lack of enthusiasm, positive interaction, and necessary cross-reinforcement of their all-important mission to preserve and improve the lives of others. Dispatching an operative to ‘go do training’ during moments eked out of a busy day, isolated with a ‘canned’ program unconsciously demonstrates an employer’s low prioritization of the training outcomes. The result may be the employee’s more casual attitude toward crucial job performance. While facts and knowledge inform daily practices and decisions, it is our experience that it is impossible to develop correct and precise manipulative skills without real-time personal observation and feedback resulting in the most effective and immediate performance/critique interactions.

Selection of a qualified candidate must be thoughtful and parametric; training must be structured and personally administered; and all testing and verification must be proctored. Only in this manner will the candidate be made fully aware of the importance of the crucial function he or she is being asked to fulfill and regard concern for quality, unvarying procedures, and cooperation with others to be an institutional mandate.

Phase 1: Informing the Student

Most students want to do well and achieve the goals set for them.
Well-chosen learning objectives will assure the student acquires all of the knowledge and skills to achieve the desired outcomes. They provide a road map for students and foster confidence that the teacher is there to assist them in achieving success. All course materials and activities should relate directly to the goals and learning objectives.

Students should be informed about the learning experience in order to understand the desired outcomes.
The concrete learning objectives for each section should be clearly defined, even read and reviewed aloud one at a time. After each learning objective is read, the students should be queried to assure they understand the objective and what will be expected of them.

Phase 2: Preparing the Student

Many of us have had the experience of watching a film more than once and seeing new things in it each time which were completely missed on the first viewing. In the best entertainment films, this can be a pleasurable effect. In the worst, we don't get enough during the first viewing to enjoy the film and never watch it again. When presenting films for the purpose of education, it is imperative that the student get it on the first viewing. Evaluating the students' reaction to a film and pacing the intervals of delivery are very important.

The Audio-Visual Viewing Guide is designed to assist the student by outlining important concepts as they are presented. Several strategies can be used by the preceptor to prepare the student for viewing to maximize the value of the experience including:

Assessment of Student Background Knowledge— An assessment of background knowledge provides important information. It allows the Preceptor to fill in any gaps in the student's assumed foundation knowledge, correct misinformation, and reinforce concepts that will underpin new materials to be presented. Care should be taken during this portion of the learning experience to correct any wrong information possessed by the students.

Building Bridges— Information collected during pre-program assessments should be organized and formalized in a way that will support the transition to each new concept to be presented. Providing the students with logical bridges from their existing knowledge base to the new concepts will greatly increase their interest and ability to organize and retain new information they encounter. A brief preview discussion of the film is recommended to increase anticipation and expectations of the viewer.

Phase 3: Presenting Information

Primacy— The educational principle of primacy is based upon the fact that what is learned the first time is usually what is retained. This has several consequences that must be taken into account when educating adult learners. Participants may have to unlearn incorrect information or techniques acquired during previous experiences that they regard as accurate. This is usually more difficult than learning new information and requires thoughtful, planned teaching techniques. Extreme care must be taken to avoid imparting incorrect information.

Intensity— This principle is based upon the fact that what is learned must be intense enough to be retained. Uninteresting, yet essential precepts must be conveyed to the adult learner with sufficient intensity to ensure retention and use in day-to-day practice. This may be accomplished in a number of ways:

The importance of the role or function that the learning supports must be established in the adult learners mind and reinforced consistently. (i.e. "The CSP compounder occupies a position the 'A List' of occupations. The 'A List' is a short listing of jobs whose performance and outcome may mean life-or-death for the client or purchaser, such as airline pilots, surgeons, and air traffic controllers.")

Important concepts or ideas contained in written material
should emphasized by use of color, highlighting, underlining,
or italicizing. The use of a highlighter is recommended as a
reading tool for important material that is otherwise
indiscernible from its context.

The use of humor, irony, or incongruity is beneficial in creating
dynamic and memorable concepts which may easily be
inserted into the adult’s long-term memory. However, sensitivity
and care should be exercised to avoid humor or anecdotes that
may be personally offensive to some individuals. Establish
limits at the socially acceptable norm.

The use of illustrations, brief stories, and most especially
artifacts (i.e. tools-of-the-trade) is especially valuable in
enhancing the intensity of most subject matter.

Written materials, films, and all other instructional aides used
by the preceptor should be evaluated for their ability to add
intensity to the subject matter.

It is important to develop reasonable styles of conversation
and analysis, which maximize intensity in the presentation
of otherwise dull materials and concepts.

Repetition— Knowledge is transferred from short- to long-term memory when it is repeated. This signals the brain that the information is important and should be retained. However, care must be taken to make these repetitions informational and prevent boredom. The key concepts are presented at least twice in the course materials; once audio-visually and once in the written form. The instructor should then incorporate a method of presenting each concept in a hands-on way, such as through group discussion of practical application or guided practice of skills. In developing course materials, key concepts can also be repeated by mentioning their application in various settings as frequently as is appropriate.

Phase 4: Implanting the Knowledge and Transfer of Learning

Transfer from Short-Term to Long-Term Memory—
Most information resides in the short-term memory for a few minutes and then vanishes unless strategies are employed to transfer it to the long-term memory. Repetition is one way to accomplish this as is presenting information in several, overlapping, and different ways (visually, verbally, written). Another excellent way to implant new information in the long-term memory is to immediately apply it to problem solving through play acting.

Transfer of Learning to Daily Practice—
Even when information is retained in the long-term memory, it will not necessarily be incorporated into actual practice without a transformation strategy. The process of transforming knowledge to actions is called transfer of learning. In most cases, this does not happen all by itself, and the job of the preceptor does not end until this concrete outcome has occurred. It is important to prepare for the transfer of learning while information is fresh and the student’s interest is high.

Phase 5: Closing the Loop; Assessment and Correction of Deficiencies

Formal Assessments— A written test of factual knowledge helps the preceptor and student identify concepts that were poorly understood or ineffectively transferred to the long-term memory. An observed practical skills test measures the transfer of knowledge to practical applications. The students should be skilled and practiced in the process that will be observed and the criteria by which their performance will be assessed.

Retraining— Retraining should be based upon an assessment of the written and practical skills test. The instructor must first identify the key concepts that relate to the missed questions or inadequate skills. Elicit the student’s engagement in this process and ask the student what aides, practice, or other information he or she feels would be beneficial. Sometimes, it is useful to have the student try to teach the information. (The process of teaching is often the best way to learn a subject.)

Assessment of Retraining— The written test following the retraining process should emphasize the subject area of difficulty. If the problems were skills-based, several repetitions of the problematic processes should be performed to assure consistency.

Ongoing Assessment and Reinforcement— The ongoing assessment and reinforcement of learned skills is the most important component in achieving desired concrete outcomes. The ongoing assessment should use the same criteria as the formal post-test of practical skills. Corrective observations should be presented in a supportive, rather than a critical, format. Personnel working together within the group should be encouraged to provide each other with positive reinforcement.

Adult Education Goals

There are several purposes for adult education. The most immediate purpose is to upgrade and optimize the way people perform their jobs, so that the quality of the product is continually improved. Adult education should enhance the growth and development of the participants as individuals and provide them with the knowledge and skills to proactively improve society.

In the context of the IV Admixtures program, these purposes can be described by the following desired outcomes.

1. The participants will perform their duties in a standardized way that improves the quality of IV admixtures produced, resulting in fewer errors and less contamination.

2. The participants will have an increased appreciation for the importance and complexity of their role, enhancing their sense of professionalism and self-worth.

3. The participants will be better able to provide information and leadership in their professional organizations and communities that will lead to a higher standard of health care practice.

Adult Characteristics

There are many techniques which may be used by the instructor to encourage the adult student to learn. They are based on the following characteristics of adults learners:

1. Adult learners are generally motivated to learn, particularly when they can apply the information immediately to their present situation. This is known as functional immediacy and requires the incorporation of examples and relevant exercises that relate the information presented directly to their daily problems.

2. Adult learners will have basic background knowledge and experience upon which learning of new concepts can be built. This is known as the building block method of learning. Prior to presentation of new material, use discussions and exercises designed to determine the level of existing knowledge and to reinforce fundamentals. These exercises will support the new information can take advantage of the students' experiences.

Adult Learning Process

The adult learning process suggests the following strategies to encourage learning:

1. Learning is best accomplished when new skills and information are built upon existing knowledge. This is another reason pre-teaching evaluations and exercises can be valuable to the instructor.

2. Adults learn best when a variety of overlapping teaching methods are used. The Aseptic Compounding program incorporates videos to provide a visual/spoken format and manuals to provide a written format. By using some of the suggested techniques discussed later in the manual, the preceptor can incorporate physical activities (such as guided practice), group activities, and self-directed exercises to enhance the learning experience.

3. Adults learn in independent and interdependent ways. Exercises which encourage interdependent learning are particularly useful in a situation such as an IV Admixtures program, because students need to work cooperatively as a team in this occupation.

Transfer of Learning

Transfer of Learning is the process of incorporating learned information into daily practices. For example:

1. Participants should be encouraged to identify ways new knowledge can be integrated into changes in daily practices.

2. Guided practice sessions should be conducted to help participants develop the physical proficiency required to transfer learning.

3. Participants should be encouraged to identify any barriers to this transfer of learning and develop strategies to overcome them. Participant-based barriers may be insufficient background knowledge, disinterest in improvement, negative social attitudes, or lack of time to develop required skills. Program-based barriers may be irrelevance of subject matter, poor teaching skills and practices, inadequate emphasis on application, insufficient follow-up, or unrealistic expectations. Organization-based barriers may include a lack of concrete organizational support, inadequate allocation of resources for adoption of new processes, lack of recognition of achievements, or a reward system that works against change. Follow-up activities are needed to verify, reinforce, and document change.